The importance of tight blood glucose control for the subsequent prevention of diabetes complications is well established: higher HbA1c levels in type 1 diabetes are associated with conditions such as retinopathy and nephropathy [1, 2]. Despite the development of diabetes therapy during recent decades, the quality of diabetes care, in general requires improvement. Effective educational programs aimed at managing glycemic control need to address not only knowledge about the procedures, but also psychosocial factors .
In order to contribute to the development of educational activities for young people with type 1 diabetes, as well as promote knowledge about diabetes, this study assesses factors that have recognized scope and impact on glycemic control: on the one hand, depressive and anxiety symptoms; and on the other, resilience, which encompasses many protective factors such as social support, hope, self-efficacy, problem-focused strategies, etc.
The knowledge each patient has about diabetes is a basic element in educational programs for type 1 diabetes patients . The patient is required to have basic knowledge about insulin, carbohydrate counting, diet, etc. Knowledge is one of many important variables involved in diabetes education. A study has demonstrated the positive impact that knowledge has on glycemic control . However, others suggest that the level of knowledge about diabetes is not a predictor of good glycemic control and generally recommend the need for further research in this field [5, 6].
The relationships between psychosocial factors and glycemic control in diabetic patients are well described in the literature. It is apparent that the chronicity of type 1 diabetes and the demands for management provide a fertile environment for adjustment problems. One of the most studied psychosocial factors in this area is depression. Depressive symptoms occur at higher levels in patients with diabetes than in the general population and are also associated with higher HbA1c levels [7–9]. Patients with diabetes who have clinical depression present higher rates of clinical complications, hospitalization and health expenditures . In patients with type 1 diabetes, depression has a significant influence on treatment adherence and health outcomes .
Resilience is a psychosocial factor that has been gaining academic importance. It is a broad concept that encompasses an individual’s resources for adequately dealing with adversity and achieving positive results in such situations. Resilience involves optimism in the face of situations, strategies for problem-focused resolution, self-efficacy, and self-confidence . In people with physical illnesses, resilience relates to factors such as self-care, adherence to treatment, quality of life as related to health, illness perception, pain perception and adherence to physical activity . In a study of individuals with type 2 diabetes, DeNisco found that HbA1c levels and resilience scores had a significant negative correlation, suggesting that resilience may influence glycemic control . In young people with diabetes, resilience is a protective factor, expressed to different degrees in each patient, when facing stressful situations .
The association of depression and diabetes mellitus is supported by numerous studies [6–10]. Some studies have evaluated the extent of resilience in diabetes patients [12–15]. However, we found no studies that simultaneously evaluated the relationship between glycemic control and knowledge about diabetes, depressive symptoms, anxiety and resilience in type 1 diabetes, particularly in young Brazilians. By better understanding the complex relationship between these factors and glycemic control, the present study will contribute to a greater understanding of the factors related to glycemic control in young people with type 1 diabetes and may also be useful for planning and implementing educational activities for such patients.
Thus, the present study aimed to (A) evaluate the correlation between glycemic control and knowledge about diabetes, resilience, anxiety, and depression in young Brazilians with type 1 diabetes and (B) verify the significant effect of each variable on glycemic control in a multiple linear regression analysis.